CONDITIONAL JOB OFFER

Applicant Name Position Date of Job Offer Company Name Representative Date of Job Offer Based on the qualifications presented on your application form and/or during your job interview, you are hereby offered a job with our organization conditional upon testing negative in an employment drug test and having an acceptable criminal background check completed. Your job offer cannot and will not be rescinded unless a review reveals that you cannot perform the essential functions of the job (with accommodations if requested), or that you present a hazard to yourself or others. False or misleading statements are also grounds for rescinding this offer. This information will be treated in strict compliance with the Fair Credit Reporting Act and the Americans with Disabilities Act. This offer is valid only if signed by a company representative. Affirmation and Authorization I HEREBY AFFIRM THAT THE INFORMATION ON THIS FORM IS TRUE AND CORRECT AND THAT THERE ARE NO OMMISSIONS. I HEREBY AUTHORIZE AND RELEASE FROM ALL LIABILITY, WITHOUT RESERVATION, ___________________________________________, DATA RESEARCH NETWORK, INC. dba: HIRE-SAFE AND ANY LAW ENFORCEMENT AGENCY, ADMINISTRATION, STATE/FEDERAL AGENCY, INSTITUTION, INFORMATION SERVICE BUREAU, EMPLOYER, EMPLOYEE, INSURANCE COMPANY,OR PERSON GATHERING OR FURNISHING THE ABOVE-MENTIONED INFORMATION. I further acknowledge that a telephone facsimile (FAX) or photographic copy of this release will be valid as the original. According to the Fair Credit Reporting Act, I am entitled to know if employment will be and is ultimately denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be advised by this employer and be given the name of the agency or source of this information. _________________________________________________________________________________________ PRINT NAME: First Middle Last Today’s Date: ____________________ Social Security Number: __________ / _______ / _________ Applicant’s Signature: _______________________________________________________________________ Company Representative Signature: ___________________________________________________________ ©2009 Data Research Network, Inc.